Serum C3/C4 ratio is a novel predictor of renal prognosis in patients with IgA nephropathy: a retrospective study

IgA nephropathy (IgAN) is an autoimmune disease associated with complement activation. It is unclear whether the ratio of serum C3 and C4 concentrations (C3/C4 ratio) can predict renal outcomes in IgAN patients. A total of 1503 patients diagnosed with IgAN via renal biopsy were recorded in this study. Poor renal outcomes were defined as >?50% decrease in the baseline estimated glomerular filtration rate (eGFR) or development of end-stage renal disease (ESRD) during follow-up. In total, 712 patients meeting the exclusion/inclusion criteria were selected, and the mean follow-up period was 40.6 (12.34) months. Patients with decreased C3/C4 ratios displayed significantly more severe clinical characteristics and renal pathological features and a higher proportion of poor renal outcomes and ESRD. The optimal multivariate Cox regression models identified the C3/C4 ratio (hazard ratio (HR) 0.63, 95% CI 0.5–0.9), serum uric acid (HR 1.58, 95% CI 1.2–2.2), serum creatinine (HR 1.3, 95% CI 1.1–1.6), systolic blood pressure (HR 1.57, 95% CI 1.2–2.0) and T score (relative to T0, T1: HR 1.96, 95% CI 1.1–3.7, T2: HR 3.03, 95% CI 1.6–5.9) as strong predictors of poor renal outcomes. Subgroup analysis showed that patients with low C3/C4 ratios benefited from glucocorticoids or other immunosuppressive agents (hazard ratio 0.30 and 0.18, 95% CI 0.13–0.72 and 0.07–0.46, respectively). Serum C3/C4 ratios may be an independent novel predictor of renal outcomes in IgAN patients. Decreased C3/C4 ratios suggest poor renal outcomes and the potential to benefit from aggressive immunosuppressive therapies.     

Association of histological subtype with risk of recurrence in craniopharyngioma patients: a systematic review and meta-analysis

It is controversial whether there is a different risk of recurrence between two histological subtypes in craniopharyngioma (CP) patients. Some reported that adamantinomatous craniopharyngioma (ACP) had a higher risk of recurrence than papillary craniopharyngioma (PCP), but others reported that there is no significant difference between them. So, we conducted this systematic review and meta-analysis to determine the association between the histological subtype of CP and the rate of recurrence. A comprehensive literature search was undertaken in PubMed, EMBASE, and Web of Science for all English articles published up to November 2020. Recurrence data stratified by ACP and PCP were extracted from studies meeting inclusion criteria. A pooled analysis of the association between the histological subtype of craniopharyngioma and rates of recurrence was performed. Thirteen articles containing 974 patients were included. When stratified by two pathological subtypes, the total recurrence rate of ACP was 26.0% and PCP was 14.1%, which showed ACP associated with a higher risk of tumor recurrence than PCP (odds ratio [OR]?=?2.12, 95% confidence interval [CI]?=?1.36, 3.30, P?=?0.00). This is the first meta-analysis focusing on histological subtypes of CP. PCP associates with a lower risk of recurrence than ACP, indicating that ACP could act as one of recurrence risk factors for CP patients. Nevertheless, large sample size and well-designed multicenter studies in which the other clinical variables are controlled to determine the histological subtype of CP as an independent recurrence risk factor are needed.

     

葛花化学成分

目的:研究葛花中的化学成分。方法:采用硅胶柱色谱、羟丙基聚葡聚糖凝胶及制备液相方法进行分离纯化,经理化和波谱鉴定化合物的结构。结果:从葛花中分离得到了5个异黄酮苷类化合物,6″-O-木糖基黄豆黄苷(6″-O-xylosylglycitin,1),5,6,7,4'-四羟基异黄酮-6,7-二葡萄糖苷(5,6,7,4'-tetrahydroxyisoflavone-6,7-di-O-β-D-glucopyranoside,2),黄豆黄苷(glycitin,3),6″-O-木糖鸢尾苷(6″-O-xylosyltectoridin,4),鸢尾苷(tectoridin,5)。结论:化合物1和3均为在国内首次从野葛花中分离报道,化合物1和2在国内未见从其他植物中分离报道。     

超声心动图诊断双腔右心室

本文报告我院自1985～1996年经手术证实的双腔右心室（DCRV）23例，超声心动图诊断与手术符合者21例，诊断符合率90．1％。DCRV的血液动力学改变与临床表现取决于右室腔内梗阻程度和并存室间隔缺损（VSD）的大小，症状出现的时间及程度和高压腔与低压腔间交通口的大小有关。本病可进行性加重，早期诊断、早期手术很重要。超声心动图检查有特征性改变。     

山药苦瓜复方制剂降低2型糖尿病大鼠血糖和血脂的实验

背景：药食两用中药山药、苦瓜和甘蔗纤维等降糖和降脂作用明显，但作用机制仍不十分清楚。目的：观察山药苦瓜复方制剂对2型糖尿病大鼠血糖、血脂、血胰岛素水平及抗感染能力的影响。设计：随机对照动物实验。单位：广东医学院科技开发中心、药理教研室、实验动物中心、中心实验室。材料：选用SPF级雌性SD大鼠80只，鼠龄4个月。二甲双胍（吉林省东北亚药业股份有限公司，批号040126）。总胆固醇、高密度脂蛋白胆固醇、三酰甘油试剂盒购于北京中生生物技术股份有限公司；Surestep Life scan血糖仪及试纸（美国强生公司）；胰岛素放射免疫试剂盒（上海海军医学研究所）；UV-3010紫外分光光度计（日本岛津）；山药苦瓜复方制剂：由广东医学院科技开发中心提供，批号040321，混悬液，由山药、苦瓜和甘蔗渣膳食纤维等成分经水提而成，其中生药含量1kg／L。方法：实验中的动物饲养和标本采集于2004-06／2005-12在广东医学院实验动物中心和科技开发中心实验室完成，指标的检测在广东医学院药理研究室和中心实验室完成。①随机选取20只为正常对照组，每天灌胃生理盐水5mL／kg。其余60只大鼠灌胃脂肪乳剂5mL／kg，1次／d，连续4周后，大鼠禁食12h，腹腔注射2g／L链脲佐菌素30mg／kg。正常对照组腹腔注射等体积柠檬酸缓冲液，3d后测随机血糖，2周后重复测血糖，以血糖水平高于13．5mmol／L或尿糖〉＋＋以上且持续2周为造模成功（n=48）。②将48只大鼠按随机摸球法分为3组：模型组，二甲双胍组和山药苦瓜复方制剂组，每组16只。模型组灌胃脂肪乳剂5mL／kg；二甲双胍组和山药苦瓜复方制剂组灌胃脂肪乳剂5mL／kg后分别灌胃二甲双胍1mg／kg和含生药1kg／L的山药苦瓜复方制剂5mL／kg。正常对照组：灌胃生理盐水5mL／kg。各组均1次／d，连续6周。③在实验结束前1天测随机血糖。禁食12h用放射免疫法测定血浆胰岛素水平，用分光光度法测定血浆总蛋白、白蛋白水平，按相应试剂盒说明测定三酰甘油、总胆固醇、高密度脂蛋白胆固醇水平。④计量资料差异比较采用方差分析，先用Levene＇s test对数据进行方差齐性检验，如方差齐用Bonferroni检验，如方差不齐则用Tamhane＇s T2检验。主要观察指标：山药苦瓜复方制剂对2型糖尿病大鼠血糖、胰岛素、血脂和血浆蛋白水平的影响。结果：造模失败脱失12只，模型组和二甲双胍组在实验过程有4，2只动物死亡，最终62只进入结果分析。①空腹血糖和血浆胰岛素测定结果：正常对照组大鼠空腹血糖水平明显低于其他3组（t=2．673-4．224，P〈0．05-0．01），血胰岛素水平明显高于其他3组（t=3．780-5．824,P〈0．05～0．01）。模型组大鼠空腹胰岛素水平明显低于山药苦瓜复方制剂组（t=2．825，P〈0．05），空腹血糖水平明显高于二甲双胍组和山药苦瓜复方制剂组（t=3．906，3．056，P〈0．05）。二甲双胍组大鼠胰岛素水平明显低于山药苦瓜复方制剂组（t=3．014，P〈0．05），但空腹血糖水平与山药苦瓜复方制剂组相近（P〉0．05）。②血脂水平测定结果：正常对照组大鼠血浆总胆固醇和三酰甘油水平明显低于其他3组，高密度脂蛋白胆固醇水平明显高于其他3组（t=2．521～4．892，P〈0．05-0．01）。模型组大鼠血浆总胆固醇水平明显高于二甲双胍组和山药苦瓜复方制剂组（t=2．466，2．512，P〈0．05），三酰甘油水平明显高于山药苦瓜复方制剂组（t=2．612，P〈0．05），高密度脂蛋白胆固醇水平明显低于山药苦瓜复方制剂组（t=3．688，P〈0．05）。二甲双胍组大鼠血浆三酰甘油水平明显高于山药苦瓜复方制剂组（t=2．620，P〈0．05）。③血浆蛋白水平测定结果：各组大鼠血浆总蛋白水平相近（P〉0．05）；正常对照组大鼠血浆白蛋白水平明显高于模型组和二甲双胍组（t=3．773，3．104，P〈0．05），与山药苦瓜复方制剂组相近（P〉0．05），白蛋白与球蛋白比值明显高于其他3组（t=2．830～3．056，P〈0．05）。模型组大鼠血浆白蛋白水平和白蛋白与球蛋白比值明显低于山药苦瓜复方制剂组（t=2．604，3．808，P〈0．05）。结论：山药苦瓜复方制剂可降低2型糖尿病模型大鼠血糖、血脂水平，升高胰岛素水平，提高抗感染能力。     

Performance of Fasting Plasma Glucose and Postprandial Urine Glucose in Screening for Diabetes in Chinese High-risk Population

Background:

The conventional approaches to diabetes screening are potentially limited by poor compliance and laboratory demand. This study aimed to evaluate the performance of fasting plasma glucose (FPG) and postprandial urine glucose (PUG) in screening for diabetes in Chinese high-risk population.

Methods:

Nine hundred and nine subjects with high-risk factors of diabetes underwent oral glucose tolerance test after an overnight fast. FPG, hemoglobin A1c, 2-h plasma glucose (2 h-PG), and 2 h-PUG were evaluated. Diabetes and prediabetes were defined by the American Diabetes Association criteria. The area under the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic accuracy of 2 h-PUG, and the optimal cut-off determined to provide the largest Youden index. Spearman correlation was used for relationship analysis.

Results:

Among 909 subjects, 33.4% (304/909) of subjects had prediabetes, and 17.2% (156/909) had diabetes. The 2 h-PUG was positively related to FPG and 2 h-PG (r = 0.428 and 0.551, respectively, both P < 0.001). For estimation of 2 h-PG ≥ 7.8 mmol/L and 2 h-PG ≥ 11.1 mmol/L using 2 h-PUG, the area under the ROC curve were 0.772 (95% confidence interval [CI ]: 0.738–0.806) and 0.885 (95% CI: 0.850–0.921), respectively. The corresponding optimal cut-offs for 2 h-PUG were 5.6 mmol/L and 7.5 mmol/L, respectively. Compared with FPG alone, FPG combined with 2 h-PUG had a higher sensitivity for detecting glucose abnormalities (84.1% vs. 73.7%, P < 0.001) and diabetes (82.7% vs. 48.1%, P < 0.001).

Conclusion:

FPG combined with 2 h-PUG substantially improves the sensitivity in detecting prediabetes and diabetes relative to FPG alone, and may represent an efficient layperson-oriented diabetes screening method.